Motor Problems Not First Effect of Parkinson's

Oct. 3,2015

MONTREAL -- The nonmotor manifestations of Parkinson's disease -- including GI and urinary problems, cognitive decline, sleep difficulty, and pain -- pose a substantial burden to patients, often being prominent before the motor problems develop, a researcher said here.

In a retrospective audit of 517 patients, 23% were graded as having a severe nonmotor symptom burden even as the Hoehn-Yahr scale of motor decline was moderate, at a median score of 2.4, reported Elisaveta Sokolov, MBBS, of King's College in London.

Moreover, the nonmotor symptom burden was very severe in 21% of patients, yet their Hoehn-Yahr scale score was a median of 2.9, which is not considered advanced from a motor perspective, Sokolov said at the World Parkinson Congress here.

"These observations suggest that even at relatively mild motor stages, the nonmotor symptom burden can be great and can have a huge impact on patients' quality of life," she said.

"Parkinson's disease is no longer considered a complex motor disorder characterized by extrapyramidal symptoms, but a progressive multisystem or multiorgan disease with variegated neurologic and nonmotor deficiencies," she explained.

Her research team has been focusing on the nonmotor aspects of Parkinson's disease not only because of their quality of life impact, but also because this can help elucidate the etiology of the disease and identify potential targets for disease-modifying drug therapies.

Patients often report that nonmotor manifestations are more disabling and less amenable to treatment than some motor symptoms.

The current study was part of a 5-year longitudinal, naturalistic study of nonmotor symptoms and progression in early and late disease; researchers also evaluated the relationship between nonmotor manifestations and motor decline.

Patients in this analysis were predominantly men, whose mean age was 68 and whose mean Hoehn-Yahr stage was 2, which reflects bilateral involvement without impairment of balance.

The scale used in this study ranged from grades 1 to 5, with grade 1 representing minimal functional disability and 5 being confinement to a wheelchair or bed. Among the 517 patients in this cohort, only 1% were classified as having grade 1, or mild, nonmotor symptoms, 30% were grade 2, or moderate, and 69% were grades 3/4, representing severe and very severe involvement.

Among those with the grade 3/4 nonmotor symptoms, some patients had specific dominant endophenotypes, featuring primarily sleep or fatigue problems.

Only a single patient had no nonmotor symptoms at all, Sokolov noted.

As with motor manifestations, many of the nonmotor symptoms are associated with Parkinson's disease itself."However, recent evidence suggests that nonmotor symptoms such as anxiety, tingling, coldness of limbs, and unclear thinking may frequently occur before motor symptoms emerge, highlighting the importance of their recognition in clinical practice," she noted.

This study emphasizes the importance of including assessments of nonmotor function in patients with Parkinson's disease with the goal of implementing true holistic care of the multi-morbid patient with the disease, she concluded.

The study was funded by the U.K. National Institute of Health Research.

http://www.medpagetoday.com/MeetingCoverage/WPC/42039